|
4! � F r Sw�y^4,$�," q �.{�-i✓ � s y • L '
<br /> aljv
<br /> � e
<br /> z v r, m ✓ p� x y�.,,�,a>�+1+'y'�!'y,d Y �qz# ,g��,yi r w � .-, � � �,.y8�+�� -.������ ! �;�, s • � '�
<br /> i` � 57 �c�i"acu�
<br /> q
<br /> :PuuTC CORD iMLEA.SE AP'PLIC'ATION
<br /> ,tom� f �j1/i� I
<br /> APPLICANT: 1 �r G LZt,4 h i y, BUSINESWAGeNcY: 17U4,04L,
<br /> ADDRESS: C�I�LPi1 W C�
<br /> Phare(1)_ z 5 --24 3 Z PHONE(2): F,4CSInnILE: ` �-5 �O Q Y
<br /> C l �,:. / G
<br /> TENTATIVE*APPOINTMENT DATE: -��r�v�-- rS Zoc 7 I .. .
<br /> Time:—LI
<br /> �..:
<br /> (Please allow 10 business days from date of application submInbl-*Tentative on(y-must be confirmed)
<br /> 1� CHEcK BOX 7o EXPEDITE REQUEST-" 3.00 FEE(CASH OR CHECK ONLY)-RSO 7.PF:4DESSE❑IN 3 BUSINESS DAYS
<br /> SIGNATURE OF APPLICANT M e, DATE �J.S G7
<br /> UNIT DISTPJBUTION 'Cl Unit 1 M Unit 2 CI [Telt 3 ClUnit 4 ❑Unit S OJI 8 .0 Other{efectronlcJllafslmaps)
<br /> FILE ADDRESS
<br /> streets Street NameCity, EHD USE ONLY
<br /> 2.
<br /> 3• zld tau Wi; �fi Lilav Sfoc k6-M
<br /> 4 2 0 5ct4A b-1 i 15 u-'l r ' S� r
<br /> �• 12,. Scyv Wi(Sar, Lva 5 c�•{-za-n _ ,' •
<br /> I
<br /> 9, /bye
<br /> P—ltlw S Oa&-fitAWT
<br /> ;,:--
<br /> Speclfla Date Range of Information Requested:From ILI' to : 6S` G ITL
<br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES44
<br /> r
<br /> Fa UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Q HousiNu ABATEMENT 'D SOun WASTE rACILITYIVEHICLE
<br /> j
<br /> 04 OTHER CLEANup srTE(NON-LOP) 0 FOOD FACILITY ..h i3 WASTE TIRE
<br /> UNDERonouNc TANK(MoNrroRINGIR'EMOvAL) ❑Ono KFNN; :GI DAIRY
<br /> �I HA2ARDOU$WASTE GmUtATOR 0 CHICKEN RANCH '113 WAMWATER TREATMENT PLANT
<br /> �J TIERED PEA6{rnm FACIUTY 11 MarELIHOTEL PUNPERTR1 OWYARDICHEM TOILET$
<br /> 13 TAT7001BODY PIERCING C1 POOUSPA LAND'USE APpLlcanaN SITS
<br /> ❑MEDICAL WhSTE FACILITY OTFiE'R(PLEASE SPECIFY)
<br /> WELL AND SEPTIC PERMIT REGOROS ARE AvxLAaLE FDR FkeWFW. MoNpAY-FRIDAY 9:00 AM-S:QQPM - EXCLUDING HOLIDAYS.
<br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the
<br /> appropriate box(es). At least one file type MUST be selected. Fax to MOM 464-6138 or mail to the address
<br /> indicated above. Address ranges will not be accepted-for additional assistance with file addresses,contact
<br /> the EHD.Applications received after 3.00 pm will be processed the next business day.
<br /> 2. The EHD will notify the applicant If any EHD files exist. An appointment for review will be confirmed
<br /> approximately ten (io)days after receipt of application. The files will be field for a maximum of five business
<br /> days for review. Appointments should be scheduled accordingly. E
<br /> 3. A file that Is actively being worked on by EHD staff may not be immediately available for review. A new
<br /> application may be submitted when the file is available.
<br /> 4. Any fila not returned in the same condition as released will be reorganizi by EHD staff at the expense of the
<br /> applicant, Future file reviews by the same applicant may require a$93.00 deposit prior to review, -
<br /> fie --- '......... .+--,....e �x•r.-.r+r aaw.FOA�,wee:.:.,-.c=s:7- .. r,.�......,c' y '+w..r-::� -' n•,r..;tirw..+a.r..r=:,ntcalw�s:3�-a..;rn. ;a;.a.::.:.,_..:>,...er� .wws,a - taF:;n"^iku-i s '.i�'..rl,
<br /> —'- .....,-s.wev....-.n.•a...vw:•ns:r ,r'- ,i 3a•.a-:..,=...a.'.u+a.ii'.�we3s;.'a'w�s.�s+:,i.�r..�+.�.tier•-..:'..::w�.crn+w+At`e+'vn.:.,.;..w.:ewn
<br /> w -.�r t �-- ,. :.: ., -,vr.K•x.-r»?��:.a�kioi„r�Mi-;`-5•'rf•�..S.e':wit�
<br /> 'S�rj - �,� �' f � wri.[a1��+vP-✓Jr4i✓:agr'a.W.:r+/+W ..vWer4;�- Nl.+tiw
<br /> }.+ _-„ � .S�'�-� ��" a ��--,3� .µ.�..�-,.,...+-,....c. s '»�.,�.oc...,.+:,,.� sr«-. �-.r�f-sw.:.,�-.�v,w..-�.r+s�iwtv��«.✓,...a.r- a•fi ,t.�t''..?s'ss
<br /> a4,i3rl
<br /> - "
<br /> _,.:. ., ., .. 3.. .:....-.,. .. .. .. '<....5 -- z.�{t--�I%•. ,;, .�, -. I�.�4� E"_ 1 'xa -�1 5.. ��'� r�ci;�1 ��.:.a
<br />
|